Would you like Woodbine to present for your event or group?
Speaker requests are accepted from groups, organizations, or individuals who are would like Woodbine to speak, present, or lead a workshop for their event or group. Please fill out this form to help us determine your needs.
Speaker Request Form
Name of group, organization, or individual who is submitting the request *
Your answer
Who is the primary contact? *
Include: Name and preferred pronouns (ex. he/she/they, etc)
Your answer
What is the primary contacts phone number?
Your answer
What is the primary contacts email?
Your answer
Is there an additional contact's information we should have?
Include: Name, email and preferred pronouns (ex. he/she/they, etc) and contact info
Your answer
Please include a short description of your group/organization
Your answer
Event Information
What is the name of the event/activity? *
Your answer
Please include a short description of the event/activity *
Your answer
Event location *
Your answer
Event purpose/goals *
Your answer
Is there a cost to attend this event?
If yes, please describe
Your answer
Is there a payment/stipend offer?
Your answer
Are there offers for complimentary (or reimbursable) dining, parking, lodging, travel costs, etc?
Your answer
Will you be filming/photographing the event?
If so, will that footage be made available for our use?
Your answer
Presentation Details
Requested topic
Your answer
Presentation format
(keynote address, roundtable, panel, workshop etc.)
Your answer
Expected Duration
(30 minutes, 1 hour, etc.)
Your answer
Will the presentation be followed by a Q&A session?
Your answer
Audience Details
Expected size of the audience
Your answer
Please describe the make-up of the audience
Include any applicable demographics (race, age, sexual orientation, gender, ability, class position) or other information about the group
Your answer
Will the media be invited?
If so, will the event be open or closed press? Also describe and submit media list.
Your answer
Community Details
How did you hear about Woodbine Ecology Center?
Your answer
How does your work relate to Woodbine's mission? *
Your answer
What larger movements are you or your group involved with? *
List as many as apply
Required
Thank you!
We will review this form as soon as possible and get back to you with our decision promptly
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